EULAR offers ‘reassuring’ COVID-19 recommendations for rheumatology population
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Individuals with rheumatic, autoimmune or musculoskeletal diseases are not at increased risk of acquiring SARS-CoV-2, according to one of the authors of the EULAR COVID-19 recommendations who addressed the EULAR 2021 Congress.
The presentation pertained to the second iteration of the recommendations for individuals with rheumatic and musculoskeletal diseases (RMDs).
“We started with the premise that patients with RMDs in general do not have higher risk when it comes to COVID-19,” Robert B.M. Landewé, MD, PhD, of the department of rheumatology and clinical immunology at the Amsterdam Rheumatology Center, and of the University of Amsterdam, in the Netherlands, told attendees. “The recommendations follow more or less expectedly.”
Landewé reviewed the “the highlights and overarching principles” of the recommendations. However, he stressed that while most guideline and recommendation documents should be based on “rational arguments from a solid and robust body of data,” not enough time has elapsed to draw absolutely certain conclusions. “There are still no rational arguments,” he said.
The group of authors convened in January, shortly after the introduction of the COVID-19 vaccines, to begin sorting through data. They considered five research questions. One was whether patients with RMDs were more likely to contract COVID-19. The next was whether those patients were likely to have a worse prognosis if they did contract COVID-19. The next pertained to the question of whether medications to treat RMDs would lead to worse outcomes of COVID-19, while the fourth considered whether RMD medications should be continued. The final question was whether patients with RMDs should be vaccinated against SARS-CoV-2.
Of more than 6,500 data sets and articles that initially underwent analysis, the recommendations ultimately used 29 articles on COVID-19 incidence, 15 on risk factors and five that included data for both incidence and risk factors.
Regarding the first question, Landewé noted that the research team concluded that patients with rheumatic and autoimmune diseases carry no increased risk of contracting COVID-19 compared with the general population. “For the moment, this reassuring,” he said.
For the prognosis of patients with RMDs who do contract COVID-19, Landewé said that “some studies suggest a higher rate of hospitalization” compared to the general population. However, taken in aggregate, the data ultimately show no worse prognosis for rheumatology populations compared to those without RMDs. “Again, a reassuring conclusion,” he said.
Another factor to consider in prognosis pertains to the risk factors for more severe disease. Landewé reported that the risk factors that apply in the general population — older age, male gender, increased BMI, cardiovascular disease, diabetes and pulmonary comorbidities, among others — also apply in rheumatology populations.
The group also considered whether certain RMDs were likely to lead to poorer COVID-19 outcomes. While some signals were observed regarding autoinflammatory diseases or connective tissue diseases, Landewé said that further investigation is necessary. “It was single studies,” he said. “The associations reported were not consistently found in studies.”
Turning to medications, it is essential to consider that patients with RMDs should continue anti-rheumatic medications as long as they are symptom free, according to Landewe. Data for specific medications showed that NSAIDS and antimalarials such as hydroxychloroquine pose no increased risk of severe COVID-19.
Regarding other treatment decisions, Landewé noted that glucocorticoids should be administered in the “lowest possible dose.” However, whether glucocorticoids themselves or other factors lead to increased risks associated with poor COVID-19 outcomes is “not completely clear.”
Finally, while the group convened after vaccines had emerged, Landewé suggested that not enough information was available to make any clear determinations. “Unfortunately, we did not include studies on vaccination,” he said. “It will come in the next version.”
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Landewe RBM. EULAR recommendations on the management of RMDs in the context of SARS-CoV-2: an update of the process. Presented at EULAR 2021 Congress; June 2-6, 2021 (virtual meeting).
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